Debating the Low Carb Diet

If you read traditional sports nutrition guides, you will often find the following recommended distribution and amounts of carbohydrates, proteins, and fats:

• Carbohydrates
  • Should be the majority (50-60%) of daily calories
  • Best sources are complex carbohydrates
    • Higher fiber multi-grain breads, pastas, and cereals
  •  Less emphasis on simple, higher sugar-based sources
    • Snack/dessert products, juices
  • Good pre-event sources, especially in higher amounts before endurance events (Carbo Loading)
• Proteins
  • Should be about 20% of daily calories
    • Meat, poultry, fish, beans, eggs, nuts
    • Dairy products
    • Cruciferous vegetables, tofu
  • Good data touting protein intake after exercise enhances muscle recovery
• Fats
  • Maximum of 30% of daily calories
    • Majority from unsaturated food sources
      • Nuts, fish, plant oils
    • Smaller amounts from animal-based sources
      • Meat and dairy products

However, there are now eloquent voices in the sports nutrition communities who are teaching a more low carbohydrate, higher protein and fat diet. I will ask you to review this podcast featuring the prominent exercise and sports medicine science expert Dr. Timothy Noakes.

Proponents of the low carbohydrate diet focus on the concept of carbohydrate intolerance where excessive carbohydrate intake (especially of processed foods) contribute to higher rates of snacking with subsequent increased risk of diabetes and overweight obesity.

Who is or might be at risk for carbohydrate intolerance?

• Anyone who is gaining weight on a high carbohydrate diet
• Family or personal history of diabetes 

What foods must be reduced/avoided?

• Carbohydrate-laden processed foods
• Breads, rice, pastas, oatmeal, grains
• High amounts of high-fructose fruits
• Juices, sodas, sports drinks,
• Crackers, chips, pretzels, cookies
• Potatoes and other starches

One would increase meats/poultry/fish and nut sources along with vegetables and dairy products. Concerned about the increase in cholesterol? Those who support the low carb/high fat and protein diet will argue that lowering blood sugar amounts is more beneficial to heart health and outweighs the risk of higher cholesterol amounts.

If interested in a low carb diet, what are recommendations to put it into place?

• Please discuss first with your medical professional, especially if you have diabetes or any other medical concerns
• Do you totally avoid carbohydrates?
  • Not recommended- rather reduce daily intake, perhaps from the usual American diet intakes of 300+ grams of carbohydrate/day to maybe 100-150 grams of carbohydrate a day
• Start reading labels- use the Carbohydrate gram amount (not percentage numbers) to guide you
• When starting, reduce eating outside the home to control content of food choices
• Monitor weight, hunger, and energy levels in the first few weeks

I post this to encourage thoughtful consideration about the on-going debate of appropriate carbohydrate intake and how each individual can best adjust their intake to optimize long-term health and athletic performance. 

Kindergarten and Weight: How to Handle the Discussion?

Most pediatric providers enjoy sharing in the rite of passage known as the pre-kindergarten physical where even the temporary discomfort of the shots and pokes cannot overcome the innocent excitement and enthusiasm of these eager young children ready to enter the formal school setting.

This visit, usually taking place between 4 1/2 to 6 years of age, just became even more intriguing with a recent report indicating that fewer than 20% of children in at-risk weight categories overcame weight issues by 5th grade, with the majority of those who returned to normal weights made the correction by 1st grade.

While the concurrent good news is that 70% of children with healthy weight in kindergarten maintained that weight classification as they grew older, the above findings are a sobering indicator that at a relatively young age, weight patterns are mostly ingrained and difficult to correct, especially after 1st grade. 

So does this portend the evolution of fad diets and aggressive weight management programs targeting the pre-school set and their families/caregivers? Are we going to amplify the angst of young families already struggling with selective eaters and worries of creating life-long body image issues?

There aren't clear answers to some of these concerns, but most importantly, this should be a reminder that those of us who take care of pre-school age children must be diligent about providing anticipatory guidance about healthy habits including meal planning, food choices/amounts, and obtaining a minimum of 45 minutes of daily vigorous physical play.  

Often the popular thought is that "children will grow into their weights" but if we heed this data, like it or not, there is a time sensitivity on appropriate weight discussion and management during those first 5-6 years of life. 

Is this data robust enough to influence how you view weight concerns in the first few years of life, and will it make you more aggressive in weight control recommendations and measures? Or do you think it will place undue guilt and pressure upon young families? Is more study needed?